2014 STD Prevention Conference

ATLANTA – A large proportion of minority men with early syphilis who have sex with men, as well as those who have sex with both men and women, acquired the infection through behaviors that are not likely to be detected during routine risk evaluations, according to an analysis of cases throughout Los Angeles County.

Latent class analysis – a statistical procedure for identifying clusters of individuals in a population – identified five relevant risk behavior subgroups among 4,178 cases of syphilis reported in men who have sex with men (MSM) and men who have sex with men and women (MSMW) between 2010 and 2012, Ryan Murphy, Ph.D., reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention. The subgroups included individuals who:

CDC

• had no identified risk (33% of cases).

• were at risk for having sex with anonymous or many partners without substance use (48%).

• were at risk for being high or intoxicated during sex, as well as having sex with many partners (11%).

• were at risk for being high or intoxicated during sex and having sex with anonymous partners (7%).

• reported all of these risk factors as well as having sex in exchange for drugs or money or trading drugs or money for sex (2%).

Once the clusters were identified, additional analysis was performed to identify variables associated with each cluster, said Dr. Murphy of the Los Angeles Department of Public Health.

"We found quite a few associations," he said.

For example, compared with whites, blacks and hispanics were more likely to be in the "no identified risk" and "substance use during sex and having sex with anonymous partners" risk groups, Dr. Murphy said.

Also, MSMW with early syphilis were more likely than MSM with early syphilis to report trading sex for drugs or money.

Geographical differences were also identified, and were very highly correlated with race/ethnicity. Those living in the metro area of Los Angeles were less likely than those in other areas to be in the "no identified risk" group, Dr. Murphy noted.

Perhaps most surprising was the finding that a third of cases had no "identified" risk, he said.

"We put ‘identified’ in quotation marks, because these are all men with early syphilis, so we know everybody’s high risk. It’s just that in that first cluster, they aren’t reporting any of the risk behaviors," he said.

Cases analyzed for this study included all cases of early syphilis – meaning cases that were still in the infectious stages – that were reported to the Los Angeles Department of Public Health Division of HIV and STD Programs from 2010 through 2012.

The findings underscore the importance of recognizing the wide range of risk behaviors that can contribute to early syphilis, Dr. Murphy said.

Also, the finding that many MSM and MSMW – particularly those living outside the metro Los Angeles area – acquire syphilis through patterns of behavior that aren’t likely to be detected during routine screening emphasizes the need to recognize that some patients at risk won’t be easily identified and raises questions about whether that group is getting less screening, and whether there are infections going untreated, he said.

This point underscores the importance of "looking at messaging to providers and making sure we are really driving home the importance of routine syphilis screening for MSM, even in the absence of reported risk behaviors," he said.

The data also highlight the value of latent class analysis for identifying particular risk groups and suggest that targeted interventions based on the risk profiles might be useful in those groups, he said.

"So we could look at those clusters and see, for example, who was reporting drug use, and then maybe that’s part of your intervention for that group or geographic area," he said.

Dr. Murphy reported having no disclosures.

ATLANTA – A large proportion of minority men with early syphilis who have sex with men, as well as those who have sex with both men and women, acquired the infection through behaviors that are not likely to be detected during routine risk evaluations, according to an analysis of cases throughout Los Angeles County.

Latent class analysis – a statistical procedure for identifying clusters of individuals in a population – identified five relevant risk behavior subgroups among 4,178 cases of syphilis reported in men who have sex with men (MSM) and men who have sex with men and women (MSMW) between 2010 and 2012, Ryan Murphy, Ph.D., reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention. The subgroups included individuals who:

CDC

• had no identified risk (33% of cases).

• were at risk for having sex with anonymous or many partners without substance use (48%).

• were at risk for being high or intoxicated during sex, as well as having sex with many partners (11%).

• were at risk for being high or intoxicated during sex and having sex with anonymous partners (7%).

• reported all of these risk factors as well as having sex in exchange for drugs or money or trading drugs or money for sex (2%).

Once the clusters were identified, additional analysis was performed to identify variables associated with each cluster, said Dr. Murphy of the Los Angeles Department of Public Health.

"We found quite a few associations," he said.

For example, compared with whites, blacks and hispanics were more likely to be in the "no identified risk" and "substance use during sex and having sex with anonymous partners" risk groups, Dr. Murphy said.

Also, MSMW with early syphilis were more likely than MSM with early syphilis to report trading sex for drugs or money.

Geographical differences were also identified, and were very highly correlated with race/ethnicity. Those living in the metro area of Los Angeles were less likely than those in other areas to be in the "no identified risk" group, Dr. Murphy noted.

Perhaps most surprising was the finding that a third of cases had no "identified" risk, he said.

"We put ‘identified’ in quotation marks, because these are all men with early syphilis, so we know everybody’s high risk. It’s just that in that first cluster, they aren’t reporting any of the risk behaviors," he said.

Cases analyzed for this study included all cases of early syphilis – meaning cases that were still in the infectious stages – that were reported to the Los Angeles Department of Public Health Division of HIV and STD Programs from 2010 through 2012.

The findings underscore the importance of recognizing the wide range of risk behaviors that can contribute to early syphilis, Dr. Murphy said.

Also, the finding that many MSM and MSMW – particularly those living outside the metro Los Angeles area – acquire syphilis through patterns of behavior that aren’t likely to be detected during routine screening emphasizes the need to recognize that some patients at risk won’t be easily identified and raises questions about whether that group is getting less screening, and whether there are infections going untreated, he said.

This point underscores the importance of "looking at messaging to providers and making sure we are really driving home the importance of routine syphilis screening for MSM, even in the absence of reported risk behaviors," he said.

The data also highlight the value of latent class analysis for identifying particular risk groups and suggest that targeted interventions based on the risk profiles might be useful in those groups, he said.

"So we could look at those clusters and see, for example, who was reporting drug use, and then maybe that’s part of your intervention for that group or geographic area," he said.

Dr. Murphy reported having no disclosures.

ATLANTA – A large proportion of minority men with early syphilis who have sex with men, as well as those who have sex with both men and women, acquired the infection through behaviors that are not likely to be detected during routine risk evaluations, according to an analysis of cases throughout Los Angeles County.

Latent class analysis – a statistical procedure for identifying clusters of individuals in a population – identified five relevant risk behavior subgroups among 4,178 cases of syphilis reported in men who have sex with men (MSM) and men who have sex with men and women (MSMW) between 2010 and 2012, Ryan Murphy, Ph.D., reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention. The subgroups included individuals who:

CDC

• had no identified risk (33% of cases).

• were at risk for having sex with anonymous or many partners without substance use (48%).

• were at risk for being high or intoxicated during sex, as well as having sex with many partners (11%).

• were at risk for being high or intoxicated during sex and having sex with anonymous partners (7%).

• reported all of these risk factors as well as having sex in exchange for drugs or money or trading drugs or money for sex (2%).

Once the clusters were identified, additional analysis was performed to identify variables associated with each cluster, said Dr. Murphy of the Los Angeles Department of Public Health.

"We found quite a few associations," he said.

For example, compared with whites, blacks and hispanics were more likely to be in the "no identified risk" and "substance use during sex and having sex with anonymous partners" risk groups, Dr. Murphy said.

Also, MSMW with early syphilis were more likely than MSM with early syphilis to report trading sex for drugs or money.

Geographical differences were also identified, and were very highly correlated with race/ethnicity. Those living in the metro area of Los Angeles were less likely than those in other areas to be in the "no identified risk" group, Dr. Murphy noted.

Perhaps most surprising was the finding that a third of cases had no "identified" risk, he said.

"We put ‘identified’ in quotation marks, because these are all men with early syphilis, so we know everybody’s high risk. It’s just that in that first cluster, they aren’t reporting any of the risk behaviors," he said.

Cases analyzed for this study included all cases of early syphilis – meaning cases that were still in the infectious stages – that were reported to the Los Angeles Department of Public Health Division of HIV and STD Programs from 2010 through 2012.

The findings underscore the importance of recognizing the wide range of risk behaviors that can contribute to early syphilis, Dr. Murphy said.

Also, the finding that many MSM and MSMW – particularly those living outside the metro Los Angeles area – acquire syphilis through patterns of behavior that aren’t likely to be detected during routine screening emphasizes the need to recognize that some patients at risk won’t be easily identified and raises questions about whether that group is getting less screening, and whether there are infections going untreated, he said.

This point underscores the importance of "looking at messaging to providers and making sure we are really driving home the importance of routine syphilis screening for MSM, even in the absence of reported risk behaviors," he said.

The data also highlight the value of latent class analysis for identifying particular risk groups and suggest that targeted interventions based on the risk profiles might be useful in those groups, he said.

"So we could look at those clusters and see, for example, who was reporting drug use, and then maybe that’s part of your intervention for that group or geographic area," he said.

Dr. Murphy reported having no disclosures.

ATLANTA – A communitywide condom distribution program is proving successful for expanding access to and awareness of free condoms, and for reducing the incidence of sexually transmitted diseases among teens in Philadelphia.

The program, which includes the Philadelphia Freedom Condom program and Take Control Philly, is a comprehensive, youth-targeted STD prevention initiative launched in April 2011 by the Philadelphia Department of Public Health (PDPH). A 2013 assessment, including interviews with 301 black/African American and/or Hispanic/Latino individuals aged 13-24 years showed that knowledge of at least one aspect of the campaign had almost doubled since 2011, when baseline data were collected from 300 individuals in that age group (97% vs. 52%), Matthew Prior of the PDPH reported in a poster at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

CDC

Furthermore, 82% of respondents in 2013 vs. 18% in 2011 reported having seen information about the Freedom Condom program, 9% in 2013 vs. 1% in 2011 said they had received a free condom from a commercial business, and 70% in 2013 vs. 58% in 2011 knew where to get free condoms.

Although there was no significant change in reported condom use at last sexual encounter between 2011 and 2013, the overall number of gonorrhea cases declined significantly from approximately 1,600 cases in the first quarter of 2011 to approximately 1,400 cases in the first quarter of 2014; the greatest decline was among adolescents, who accounted for about 8% of cases in the first quarter of 2011 vs. about 5% in the first quarter of 2014, Mr. Prior found.

This followed a 38% increase in the number of gonorrhea cases among adolescents from 2009 to 2010, he noted.

The Freedom Condom program aimed to improve access to condoms, in part through a free condom mailing program, and Take Control Philly aimed to prevent STDs among adolescents through a sexual health awareness campaign and by addressing sexual risk-taking behaviors among a target population. Baseline data showed that 61% of adolescents surveyed had ever had sexual intercourse, 15% had sexual intercourse before the age of 13 years, 40.4% did not use a condom during their last sexual intercourse, and 27.2% had sexual intercourse with four or more persons during their lifetime.

"Multiple strategies were used to promote the Take Control Philly website and the Freedom Condom [program], including social media advertisement, traditional media advertisement, expanded condom distribution, community event outreach, and promotion in Philadelphia public high schools," Mr. Prior wrote.

Between April 2011 and 2014, more than 8.2 million condoms were distributed through the program. The success in promoting the program is due in part to the Philadelphia health commissioner and other city health leaders, whose support was pivotal to the planning and launch of the initiative, he noted.

Also, promotion of the program website through traditional media avenues and Facebook advertising was effective for increasing website traffic and condom mailing requests, he said.

"Communitywide condom distribution expansion is a promising approach for addressing STDs in youth," he concluded, adding that using multiple strategies for increasing program awareness is necessary for reaching youth.

Mr. Prior reported having no relevant financial disclosures.

ATLANTA – A communitywide condom distribution program is proving successful for expanding access to and awareness of free condoms, and for reducing the incidence of sexually transmitted diseases among teens in Philadelphia.

The program, which includes the Philadelphia Freedom Condom program and Take Control Philly, is a comprehensive, youth-targeted STD prevention initiative launched in April 2011 by the Philadelphia Department of Public Health (PDPH). A 2013 assessment, including interviews with 301 black/African American and/or Hispanic/Latino individuals aged 13-24 years showed that knowledge of at least one aspect of the campaign had almost doubled since 2011, when baseline data were collected from 300 individuals in that age group (97% vs. 52%), Matthew Prior of the PDPH reported in a poster at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

CDC

Furthermore, 82% of respondents in 2013 vs. 18% in 2011 reported having seen information about the Freedom Condom program, 9% in 2013 vs. 1% in 2011 said they had received a free condom from a commercial business, and 70% in 2013 vs. 58% in 2011 knew where to get free condoms.

Although there was no significant change in reported condom use at last sexual encounter between 2011 and 2013, the overall number of gonorrhea cases declined significantly from approximately 1,600 cases in the first quarter of 2011 to approximately 1,400 cases in the first quarter of 2014; the greatest decline was among adolescents, who accounted for about 8% of cases in the first quarter of 2011 vs. about 5% in the first quarter of 2014, Mr. Prior found.

This followed a 38% increase in the number of gonorrhea cases among adolescents from 2009 to 2010, he noted.

The Freedom Condom program aimed to improve access to condoms, in part through a free condom mailing program, and Take Control Philly aimed to prevent STDs among adolescents through a sexual health awareness campaign and by addressing sexual risk-taking behaviors among a target population. Baseline data showed that 61% of adolescents surveyed had ever had sexual intercourse, 15% had sexual intercourse before the age of 13 years, 40.4% did not use a condom during their last sexual intercourse, and 27.2% had sexual intercourse with four or more persons during their lifetime.

"Multiple strategies were used to promote the Take Control Philly website and the Freedom Condom [program], including social media advertisement, traditional media advertisement, expanded condom distribution, community event outreach, and promotion in Philadelphia public high schools," Mr. Prior wrote.

Between April 2011 and 2014, more than 8.2 million condoms were distributed through the program. The success in promoting the program is due in part to the Philadelphia health commissioner and other city health leaders, whose support was pivotal to the planning and launch of the initiative, he noted.

Also, promotion of the program website through traditional media avenues and Facebook advertising was effective for increasing website traffic and condom mailing requests, he said.

"Communitywide condom distribution expansion is a promising approach for addressing STDs in youth," he concluded, adding that using multiple strategies for increasing program awareness is necessary for reaching youth.

Mr. Prior reported having no relevant financial disclosures.

ATLANTA – A communitywide condom distribution program is proving successful for expanding access to and awareness of free condoms, and for reducing the incidence of sexually transmitted diseases among teens in Philadelphia.

The program, which includes the Philadelphia Freedom Condom program and Take Control Philly, is a comprehensive, youth-targeted STD prevention initiative launched in April 2011 by the Philadelphia Department of Public Health (PDPH). A 2013 assessment, including interviews with 301 black/African American and/or Hispanic/Latino individuals aged 13-24 years showed that knowledge of at least one aspect of the campaign had almost doubled since 2011, when baseline data were collected from 300 individuals in that age group (97% vs. 52%), Matthew Prior of the PDPH reported in a poster at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

CDC

Furthermore, 82% of respondents in 2013 vs. 18% in 2011 reported having seen information about the Freedom Condom program, 9% in 2013 vs. 1% in 2011 said they had received a free condom from a commercial business, and 70% in 2013 vs. 58% in 2011 knew where to get free condoms.

Although there was no significant change in reported condom use at last sexual encounter between 2011 and 2013, the overall number of gonorrhea cases declined significantly from approximately 1,600 cases in the first quarter of 2011 to approximately 1,400 cases in the first quarter of 2014; the greatest decline was among adolescents, who accounted for about 8% of cases in the first quarter of 2011 vs. about 5% in the first quarter of 2014, Mr. Prior found.

This followed a 38% increase in the number of gonorrhea cases among adolescents from 2009 to 2010, he noted.

The Freedom Condom program aimed to improve access to condoms, in part through a free condom mailing program, and Take Control Philly aimed to prevent STDs among adolescents through a sexual health awareness campaign and by addressing sexual risk-taking behaviors among a target population. Baseline data showed that 61% of adolescents surveyed had ever had sexual intercourse, 15% had sexual intercourse before the age of 13 years, 40.4% did not use a condom during their last sexual intercourse, and 27.2% had sexual intercourse with four or more persons during their lifetime.

"Multiple strategies were used to promote the Take Control Philly website and the Freedom Condom [program], including social media advertisement, traditional media advertisement, expanded condom distribution, community event outreach, and promotion in Philadelphia public high schools," Mr. Prior wrote.

Between April 2011 and 2014, more than 8.2 million condoms were distributed through the program. The success in promoting the program is due in part to the Philadelphia health commissioner and other city health leaders, whose support was pivotal to the planning and launch of the initiative, he noted.

Also, promotion of the program website through traditional media avenues and Facebook advertising was effective for increasing website traffic and condom mailing requests, he said.

"Communitywide condom distribution expansion is a promising approach for addressing STDs in youth," he concluded, adding that using multiple strategies for increasing program awareness is necessary for reaching youth.

Mr. Prior reported having no relevant financial disclosures.

ATLANTA – Extragenital chlamydia and gonorrhea infections are common among men who have sex with men, but screening for extragenital infection is far less common than urethral testing, according to a study of clinic patients.

The lack of extragenital testing likely resulted in a substantial number of missed infections in the clinic population, Roberta Scheinmann of Public Health Solutions, New York, reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The prevalence of urethral testing among 300 HIV-positive men evaluated at a federally qualified health center in 2011 was 71%, compared with 47% for rectal testing and 40% for pharyngeal testing. Just over a third of the men were tested at all three sites.

Overall, 9% of patients tested positive for chlamydia at any anatomic site, and 9% tested positive for gonorrhea at any anatomic site. Among those who had a rectal test, 14% and 9% were positive for chlamydia and gonorrhea, respectively, Ms. Scheinmann said.

Of the chlamydia cases, about half were rectal. Of the gonorrhea cases 35% were rectal and 23% were pharyngeal.

Based on these findings and the testing rates in this study, an estimated 143 extragenital gonorrhea infections were missed in the clinic population during the study year, and an estimated 223 extragenital chlamydia infections were missed, Ms. Scheinmann said.

Patients were selected randomly from among about 3,000 HIV-positive men who have sex with men who were seen at least once at the center during 2011, and demographic data and data regarding anatomic sites of testing in the year prior to the visit were abstracted from medical records. The patients had a median age of 39 years, more than half were aged 40 or older, 40% were on Medicaid, and about a third were part of the AIDS Drug Assistance Programs.

The median number of medical visits during the study period was six, so the patients "were quite connected to care," she said.

The rates of coinfection among HIV-positive men who have sex with men is high, and the findings of this study are consistent with those from prior studies showing low rates of extragenital testing and high rates of missed infection in this population. In one study, HIV-positive men were rectally screened only 2%-9% of the time, and in another, half of all chlamydia cases and about two-thirds of gonorrhea cases were missed, Ms. Scheinmann said.

Further evaluation to identify potential barriers to screening and missed opportunities for screening is currently underway, as is an effort to improve screening rates, she said.

Ms. Scheinmann reported having no relevant financial disclosures.

ATLANTA – Extragenital chlamydia and gonorrhea infections are common among men who have sex with men, but screening for extragenital infection is far less common than urethral testing, according to a study of clinic patients.

The lack of extragenital testing likely resulted in a substantial number of missed infections in the clinic population, Roberta Scheinmann of Public Health Solutions, New York, reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The prevalence of urethral testing among 300 HIV-positive men evaluated at a federally qualified health center in 2011 was 71%, compared with 47% for rectal testing and 40% for pharyngeal testing. Just over a third of the men were tested at all three sites.

Overall, 9% of patients tested positive for chlamydia at any anatomic site, and 9% tested positive for gonorrhea at any anatomic site. Among those who had a rectal test, 14% and 9% were positive for chlamydia and gonorrhea, respectively, Ms. Scheinmann said.

Of the chlamydia cases, about half were rectal. Of the gonorrhea cases 35% were rectal and 23% were pharyngeal.

Based on these findings and the testing rates in this study, an estimated 143 extragenital gonorrhea infections were missed in the clinic population during the study year, and an estimated 223 extragenital chlamydia infections were missed, Ms. Scheinmann said.

Patients were selected randomly from among about 3,000 HIV-positive men who have sex with men who were seen at least once at the center during 2011, and demographic data and data regarding anatomic sites of testing in the year prior to the visit were abstracted from medical records. The patients had a median age of 39 years, more than half were aged 40 or older, 40% were on Medicaid, and about a third were part of the AIDS Drug Assistance Programs.

The median number of medical visits during the study period was six, so the patients "were quite connected to care," she said.

The rates of coinfection among HIV-positive men who have sex with men is high, and the findings of this study are consistent with those from prior studies showing low rates of extragenital testing and high rates of missed infection in this population. In one study, HIV-positive men were rectally screened only 2%-9% of the time, and in another, half of all chlamydia cases and about two-thirds of gonorrhea cases were missed, Ms. Scheinmann said.

Further evaluation to identify potential barriers to screening and missed opportunities for screening is currently underway, as is an effort to improve screening rates, she said.

Ms. Scheinmann reported having no relevant financial disclosures.

ATLANTA – Extragenital chlamydia and gonorrhea infections are common among men who have sex with men, but screening for extragenital infection is far less common than urethral testing, according to a study of clinic patients.

The lack of extragenital testing likely resulted in a substantial number of missed infections in the clinic population, Roberta Scheinmann of Public Health Solutions, New York, reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The prevalence of urethral testing among 300 HIV-positive men evaluated at a federally qualified health center in 2011 was 71%, compared with 47% for rectal testing and 40% for pharyngeal testing. Just over a third of the men were tested at all three sites.

Overall, 9% of patients tested positive for chlamydia at any anatomic site, and 9% tested positive for gonorrhea at any anatomic site. Among those who had a rectal test, 14% and 9% were positive for chlamydia and gonorrhea, respectively, Ms. Scheinmann said.

Of the chlamydia cases, about half were rectal. Of the gonorrhea cases 35% were rectal and 23% were pharyngeal.

Based on these findings and the testing rates in this study, an estimated 143 extragenital gonorrhea infections were missed in the clinic population during the study year, and an estimated 223 extragenital chlamydia infections were missed, Ms. Scheinmann said.

Patients were selected randomly from among about 3,000 HIV-positive men who have sex with men who were seen at least once at the center during 2011, and demographic data and data regarding anatomic sites of testing in the year prior to the visit were abstracted from medical records. The patients had a median age of 39 years, more than half were aged 40 or older, 40% were on Medicaid, and about a third were part of the AIDS Drug Assistance Programs.

The median number of medical visits during the study period was six, so the patients "were quite connected to care," she said.

The rates of coinfection among HIV-positive men who have sex with men is high, and the findings of this study are consistent with those from prior studies showing low rates of extragenital testing and high rates of missed infection in this population. In one study, HIV-positive men were rectally screened only 2%-9% of the time, and in another, half of all chlamydia cases and about two-thirds of gonorrhea cases were missed, Ms. Scheinmann said.

Further evaluation to identify potential barriers to screening and missed opportunities for screening is currently underway, as is an effort to improve screening rates, she said.

Ms. Scheinmann reported having no relevant financial disclosures.

ATLANTA – A communitywide condom distribution program is proving successful for expanding access to and awareness of free condoms, and for reducing the incidence of sexually transmitted diseases among teens in Philadelphia.

The program, which includes the Philadelphia Freedom Condom program and Take Control Philly, is a comprehensive, youth-targeted STD prevention initiative launched in April 2011 by the Philadelphia Department of Public Health (PDPH). A 2013 assessment, including interviews with 301 black/African American and/or Hispanic/Latino individuals aged 13-24 years showed that knowledge of at least one aspect of the campaign had almost doubled since 2011, when baseline data were collected from 300 individuals in that age group (97% vs. 52%), Matthew Prior of the PDPH reported in a poster at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

CDC

Furthermore, 82% of respondents in 2013 vs. 18% in 2011 reported having seen information about the Freedom Condom program, 9% in 2013 vs. 1% in 2011 said they had received a free condom from a commercial business, and 70% in 2013 vs. 58% in 2011 knew where to get free condoms.

Although there was no significant change in reported condom use at last sexual encounter between 2011 and 2013, the overall number of gonorrhea cases declined significantly from approximately 1,600 cases in the first quarter of 2011 to approximately 1,400 cases in the first quarter of 2104; the greatest decline was among adolescents, who accounted for about 8% of cases in the first quarter of 2011 vs. about 5% in the first quarter of 2014, Mr. Prior found.

This followed a 38% increase in the number of gonorrhea cases among adolescents from 2009 to 2010, he noted.

The Freedom Condom program aimed to improve access to condoms, in part through a free condom mailing program, and Take Control Philly aimed to prevent STDs among adolescents through a sexual health awareness campaign and by addressing sexual risk-taking behaviors among a target population. Baseline data showed that 61% of adolescents surveyed had ever had sexual intercourse, 15% had sexual intercourse before the age of 13 years, 40.4% did not use a condom during their last sexual intercourse, and 27.2% had sexual intercourse with four or more persons during their lifetime.

"Multiple strategies were used to promote the Take Control Philly website and the Freedom Condom [program], including social media advertisement, traditional media advertisement, expanded condom distribution, community event outreach, and promotion in Philadelphia public high schools," Mr. Prior wrote.

Between April 2011 and 2014, more than 8.2 million condoms were distributed through the program. The success in promoting the program is due in part to the Philadelphia health commissioner and other city health leaders, whose support was pivotal to the planning and launch of the initiative, he noted.

Also, promotion of the program website through traditional media avenues and Facebook advertising was effective for increasing website traffic and condom mailing requests, he said.

"Communitywide condom distribution expansion is a promising approach for addressing STDs in youth," he concluded, adding that using multiple strategies for increasing program awareness is necessary for reaching youth.

Mr. Prior reported having no relevant financial disclosures.

ATLANTA – A communitywide condom distribution program is proving successful for expanding access to and awareness of free condoms, and for reducing the incidence of sexually transmitted diseases among teens in Philadelphia.

The program, which includes the Philadelphia Freedom Condom program and Take Control Philly, is a comprehensive, youth-targeted STD prevention initiative launched in April 2011 by the Philadelphia Department of Public Health (PDPH). A 2013 assessment, including interviews with 301 black/African American and/or Hispanic/Latino individuals aged 13-24 years showed that knowledge of at least one aspect of the campaign had almost doubled since 2011, when baseline data were collected from 300 individuals in that age group (97% vs. 52%), Matthew Prior of the PDPH reported in a poster at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

CDC

Furthermore, 82% of respondents in 2013 vs. 18% in 2011 reported having seen information about the Freedom Condom program, 9% in 2013 vs. 1% in 2011 said they had received a free condom from a commercial business, and 70% in 2013 vs. 58% in 2011 knew where to get free condoms.

Although there was no significant change in reported condom use at last sexual encounter between 2011 and 2013, the overall number of gonorrhea cases declined significantly from approximately 1,600 cases in the first quarter of 2011 to approximately 1,400 cases in the first quarter of 2104; the greatest decline was among adolescents, who accounted for about 8% of cases in the first quarter of 2011 vs. about 5% in the first quarter of 2014, Mr. Prior found.

This followed a 38% increase in the number of gonorrhea cases among adolescents from 2009 to 2010, he noted.

The Freedom Condom program aimed to improve access to condoms, in part through a free condom mailing program, and Take Control Philly aimed to prevent STDs among adolescents through a sexual health awareness campaign and by addressing sexual risk-taking behaviors among a target population. Baseline data showed that 61% of adolescents surveyed had ever had sexual intercourse, 15% had sexual intercourse before the age of 13 years, 40.4% did not use a condom during their last sexual intercourse, and 27.2% had sexual intercourse with four or more persons during their lifetime.

"Multiple strategies were used to promote the Take Control Philly website and the Freedom Condom [program], including social media advertisement, traditional media advertisement, expanded condom distribution, community event outreach, and promotion in Philadelphia public high schools," Mr. Prior wrote.

Between April 2011 and 2014, more than 8.2 million condoms were distributed through the program. The success in promoting the program is due in part to the Philadelphia health commissioner and other city health leaders, whose support was pivotal to the planning and launch of the initiative, he noted.

Also, promotion of the program website through traditional media avenues and Facebook advertising was effective for increasing website traffic and condom mailing requests, he said.

"Communitywide condom distribution expansion is a promising approach for addressing STDs in youth," he concluded, adding that using multiple strategies for increasing program awareness is necessary for reaching youth.

Mr. Prior reported having no relevant financial disclosures.

ATLANTA – A communitywide condom distribution program is proving successful for expanding access to and awareness of free condoms, and for reducing the incidence of sexually transmitted diseases among teens in Philadelphia.

The program, which includes the Philadelphia Freedom Condom program and Take Control Philly, is a comprehensive, youth-targeted STD prevention initiative launched in April 2011 by the Philadelphia Department of Public Health (PDPH). A 2013 assessment, including interviews with 301 black/African American and/or Hispanic/Latino individuals aged 13-24 years showed that knowledge of at least one aspect of the campaign had almost doubled since 2011, when baseline data were collected from 300 individuals in that age group (97% vs. 52%), Matthew Prior of the PDPH reported in a poster at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

CDC

Furthermore, 82% of respondents in 2013 vs. 18% in 2011 reported having seen information about the Freedom Condom program, 9% in 2013 vs. 1% in 2011 said they had received a free condom from a commercial business, and 70% in 2013 vs. 58% in 2011 knew where to get free condoms.

Although there was no significant change in reported condom use at last sexual encounter between 2011 and 2013, the overall number of gonorrhea cases declined significantly from approximately 1,600 cases in the first quarter of 2011 to approximately 1,400 cases in the first quarter of 2104; the greatest decline was among adolescents, who accounted for about 8% of cases in the first quarter of 2011 vs. about 5% in the first quarter of 2014, Mr. Prior found.

This followed a 38% increase in the number of gonorrhea cases among adolescents from 2009 to 2010, he noted.

The Freedom Condom program aimed to improve access to condoms, in part through a free condom mailing program, and Take Control Philly aimed to prevent STDs among adolescents through a sexual health awareness campaign and by addressing sexual risk-taking behaviors among a target population. Baseline data showed that 61% of adolescents surveyed had ever had sexual intercourse, 15% had sexual intercourse before the age of 13 years, 40.4% did not use a condom during their last sexual intercourse, and 27.2% had sexual intercourse with four or more persons during their lifetime.

"Multiple strategies were used to promote the Take Control Philly website and the Freedom Condom [program], including social media advertisement, traditional media advertisement, expanded condom distribution, community event outreach, and promotion in Philadelphia public high schools," Mr. Prior wrote.

Between April 2011 and 2014, more than 8.2 million condoms were distributed through the program. The success in promoting the program is due in part to the Philadelphia health commissioner and other city health leaders, whose support was pivotal to the planning and launch of the initiative, he noted.

Also, promotion of the program website through traditional media avenues and Facebook advertising was effective for increasing website traffic and condom mailing requests, he said.

"Communitywide condom distribution expansion is a promising approach for addressing STDs in youth," he concluded, adding that using multiple strategies for increasing program awareness is necessary for reaching youth.

Mr. Prior reported having no relevant financial disclosures.

ATLANTA – The annual incidence of genital warts declined by 69% between 2006 and 2013 at a large public university after human papillomavirus vaccination was available, despite a relatively low intake among adolescents and college students less than 18 years old.

The proportion of students diagnosed with genital warts at a health center at the University of Wisconsin, Madison, in 2006 was 1.3% (222 students), compared with 0.5% (88 students) in 2013, Craig M. Roberts reported in a late-breaking poster at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

©luiscar/Thinkstockphotos.com

About 90% of cases of external genital warts are caused by HPV types 6 or 11, which are included in the quadrivalent HPV vaccine that was licensed in the United States in 2006.

In this study, genital warts were used as a surrogate marker for HPV infection. The incidence declined each year from 2008 to 2013, noted Mr. Roberts, an epidemiologist and clinical assistant professor at the University of Wisconsin.

Among students entering the university between 2006 and 2013, 64% of women but only 15% of men reported receiving at least one dose of HPV vaccine. Despite the large difference in vaccination coverage, the reduction in the incidence of genital warts was similar between genders (75.7% for women and 67.6% for men).

In 2006, the overall incidence of genital warts was 15.7 per 1,000 (10.8 for women and 26.0 for men), compared with 4.8 per 1,000 (2.6 for women and 8.4 for men) in 2014.

The rates of vaccine completion did, however, increase each year between 2006 and 2013, Mr. Roberts noted. Vaccine uptake among women was 58.5% in 2006 and 69.7% in 2013; vaccination among men was 0.5% in 2006 and 36.9% in 2013.

The findings were based on a review of medical records for visits to the health center between January 2008 and December 2013. The data were compared with baseline records from 2006. Only initial genital warts diagnoses were included in the analysis.

"These data demonstrate the striking decreases in the incidence of genital wart diagnoses in a population of college students after the introduction of a quadrivalent HPV vaccine in the United States. Declines occurred rapidly over 7 years in this population of sexually active young adults, despite less than optimal levels of vaccine coverage," Mr. Roberts wrote.

The findings suggest that cross-protection for male partners occurred as immunization rates increased among women; the incidence in men began to decline even before a recommendation for HPV vaccination for men was in place.

The findings were limited by the study design, and by the possibility that students may have been diagnosed in settings other than the student health center. However, the results suggest that colleges and universities should continue to promote and provide HPV vaccine to students to achieve further reductions in disease incidence, Mr. Roberts concluded.

Mr. Roberts reported having no disclosures.

ATLANTA – The annual incidence of genital warts declined by 69% between 2006 and 2013 at a large public university after human papillomavirus vaccination was available, despite a relatively low intake among adolescents and college students less than 18 years old.

The proportion of students diagnosed with genital warts at a health center at the University of Wisconsin, Madison, in 2006 was 1.3% (222 students), compared with 0.5% (88 students) in 2013, Craig M. Roberts reported in a late-breaking poster at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

©luiscar/Thinkstockphotos.com

About 90% of cases of external genital warts are caused by HPV types 6 or 11, which are included in the quadrivalent HPV vaccine that was licensed in the United States in 2006.

In this study, genital warts were used as a surrogate marker for HPV infection. The incidence declined each year from 2008 to 2013, noted Mr. Roberts, an epidemiologist and clinical assistant professor at the University of Wisconsin.

Among students entering the university between 2006 and 2013, 64% of women but only 15% of men reported receiving at least one dose of HPV vaccine. Despite the large difference in vaccination coverage, the reduction in the incidence of genital warts was similar between genders (75.7% for women and 67.6% for men).

In 2006, the overall incidence of genital warts was 15.7 per 1,000 (10.8 for women and 26.0 for men), compared with 4.8 per 1,000 (2.6 for women and 8.4 for men) in 2014.

The rates of vaccine completion did, however, increase each year between 2006 and 2013, Mr. Roberts noted. Vaccine uptake among women was 58.5% in 2006 and 69.7% in 2013; vaccination among men was 0.5% in 2006 and 36.9% in 2013.

The findings were based on a review of medical records for visits to the health center between January 2008 and December 2013. The data were compared with baseline records from 2006. Only initial genital warts diagnoses were included in the analysis.

"These data demonstrate the striking decreases in the incidence of genital wart diagnoses in a population of college students after the introduction of a quadrivalent HPV vaccine in the United States. Declines occurred rapidly over 7 years in this population of sexually active young adults, despite less than optimal levels of vaccine coverage," Mr. Roberts wrote.

The findings suggest that cross-protection for male partners occurred as immunization rates increased among women; the incidence in men began to decline even before a recommendation for HPV vaccination for men was in place.

The findings were limited by the study design, and by the possibility that students may have been diagnosed in settings other than the student health center. However, the results suggest that colleges and universities should continue to promote and provide HPV vaccine to students to achieve further reductions in disease incidence, Mr. Roberts concluded.

Mr. Roberts reported having no disclosures.

ATLANTA – The annual incidence of genital warts declined by 69% between 2006 and 2013 at a large public university after human papillomavirus vaccination was available, despite a relatively low intake among adolescents and college students less than 18 years old.

The proportion of students diagnosed with genital warts at a health center at the University of Wisconsin, Madison, in 2006 was 1.3% (222 students), compared with 0.5% (88 students) in 2013, Craig M. Roberts reported in a late-breaking poster at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

©luiscar/Thinkstockphotos.com

About 90% of cases of external genital warts are caused by HPV types 6 or 11, which are included in the quadrivalent HPV vaccine that was licensed in the United States in 2006.

In this study, genital warts were used as a surrogate marker for HPV infection. The incidence declined each year from 2008 to 2013, noted Mr. Roberts, an epidemiologist and clinical assistant professor at the University of Wisconsin.

Among students entering the university between 2006 and 2013, 64% of women but only 15% of men reported receiving at least one dose of HPV vaccine. Despite the large difference in vaccination coverage, the reduction in the incidence of genital warts was similar between genders (75.7% for women and 67.6% for men).

In 2006, the overall incidence of genital warts was 15.7 per 1,000 (10.8 for women and 26.0 for men), compared with 4.8 per 1,000 (2.6 for women and 8.4 for men) in 2014.

The rates of vaccine completion did, however, increase each year between 2006 and 2013, Mr. Roberts noted. Vaccine uptake among women was 58.5% in 2006 and 69.7% in 2013; vaccination among men was 0.5% in 2006 and 36.9% in 2013.

The findings were based on a review of medical records for visits to the health center between January 2008 and December 2013. The data were compared with baseline records from 2006. Only initial genital warts diagnoses were included in the analysis.

"These data demonstrate the striking decreases in the incidence of genital wart diagnoses in a population of college students after the introduction of a quadrivalent HPV vaccine in the United States. Declines occurred rapidly over 7 years in this population of sexually active young adults, despite less than optimal levels of vaccine coverage," Mr. Roberts wrote.

The findings suggest that cross-protection for male partners occurred as immunization rates increased among women; the incidence in men began to decline even before a recommendation for HPV vaccination for men was in place.

The findings were limited by the study design, and by the possibility that students may have been diagnosed in settings other than the student health center. However, the results suggest that colleges and universities should continue to promote and provide HPV vaccine to students to achieve further reductions in disease incidence, Mr. Roberts concluded.

Mr. Roberts reported having no disclosures.

ATLANTA – Educating patients treated for chlamydia or gonorrhea about reinfection and retesting, and providing customized options for follow-up care, increased patient retest return rates by 15% in a prospective cohort study.

The return rate at 1-6 months after treatment among 1,454 patients who received enhanced educational information about reinfection and the importance of retesting during the first phase of the InTOUCH study was 59%, and the return rate among 575 patients who received that educational information along with customized reminders and/or a mailed-in home testing kit in a second phase was 62%, compared with a return rate of 54% among 2,696 historical controls, Holly Howard reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The increases in return rates were statistically significant, said Ms. Howard of the California Department of Public Health, Richmond.

The initial education phase of the multicenter study occurred in 2010 and 2011 at six geographically diverse California Title X clinics. Participants were clients of the California Family Planning, Access, Care, and Treatment Program, which provides care to more than 2 million low-income women each year.

The patients were counseled about the risks and dangers of re-infection and the importance of retesting, and were given tips for remembering to return for retesting. Additionally, educational materials were updated to improve readability and user friendliness.

During 2011 and 2012, patients from the educational phase who tested positive for chlamydia or gonorrhea, and who were treated for the infections, were officially enrolled in the second phase of the study, during which they were offered the option of receiving retest reminders via postcard, text, and/or e-mail, as well as the option of retesting with a home test sent to their address 3 months after treatment.

Most patients (90%) opted to receive retest reminders, and most of those chose text and e-mail reminders. Only 5% chose to use the home test kit.

The findings have implications for improving the notoriously low return rates among women who test positive for chlamydia and gonorrhea infection. These infections are common and are associated with serious reproductive health sequelae, including an increased risk of pelvic inflammatory disease and ectopic pregnancy, Ms. Howard noted.

Routine retesting within a few months of treatment allows for early identification of reinfection, and for retreatment that can reduce the risk of adverse outcomes.

For more than a decade, national guidelines have recommended retesting of patients with chlamydia or gonorrhea, but retesting rates have remained stubbornly below 50%. Effective strategies for increasing patient retest return rates have been elusive, she noted.

In the year leading up to the InTOUCH study, only 44% of clinic patients overall were retested, and that was found to be a result both of the low (62%) return rate and low (69%) retesting rate among those who did return, she said.

The overall retesting rate improved to nearly 60% during the course of the study.

"So with a very moderate increase in patient return rates and in clinic retesting rates among returning patients, you can see that we cumulatively increased our overall retesting rates by more than 30%," she said, noting that given the consistently low return rates in prior years, this was "a very exciting result."

The current findings suggest that addressing the factors that contribute to low return rates, including lack of information about the importance of returning, forgetting to return, and difficulties getting to the clinic, can lead to significant improvement in return rates, Ms. Howard said.

"Improving is dependent on addressing both patient and clinic level causes. Through a combination of these very feasible interventions, we were able to increase the overall retesting rates by 32%," she said.

The InTOUCH study was funded by a grant from the Office of Population Affairs as a Title X Service Delivery Improvement Research Project. Ms. Howard reported having no other disclosures.

ATLANTA – Educating patients treated for chlamydia or gonorrhea about reinfection and retesting, and providing customized options for follow-up care, increased patient retest return rates by 15% in a prospective cohort study.

The return rate at 1-6 months after treatment among 1,454 patients who received enhanced educational information about reinfection and the importance of retesting during the first phase of the InTOUCH study was 59%, and the return rate among 575 patients who received that educational information along with customized reminders and/or a mailed-in home testing kit in a second phase was 62%, compared with a return rate of 54% among 2,696 historical controls, Holly Howard reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The increases in return rates were statistically significant, said Ms. Howard of the California Department of Public Health, Richmond.

The initial education phase of the multicenter study occurred in 2010 and 2011 at six geographically diverse California Title X clinics. Participants were clients of the California Family Planning, Access, Care, and Treatment Program, which provides care to more than 2 million low-income women each year.

The patients were counseled about the risks and dangers of re-infection and the importance of retesting, and were given tips for remembering to return for retesting. Additionally, educational materials were updated to improve readability and user friendliness.

During 2011 and 2012, patients from the educational phase who tested positive for chlamydia or gonorrhea, and who were treated for the infections, were officially enrolled in the second phase of the study, during which they were offered the option of receiving retest reminders via postcard, text, and/or e-mail, as well as the option of retesting with a home test sent to their address 3 months after treatment.

Most patients (90%) opted to receive retest reminders, and most of those chose text and e-mail reminders. Only 5% chose to use the home test kit.

The findings have implications for improving the notoriously low return rates among women who test positive for chlamydia and gonorrhea infection. These infections are common and are associated with serious reproductive health sequelae, including an increased risk of pelvic inflammatory disease and ectopic pregnancy, Ms. Howard noted.

Routine retesting within a few months of treatment allows for early identification of reinfection, and for retreatment that can reduce the risk of adverse outcomes.

For more than a decade, national guidelines have recommended retesting of patients with chlamydia or gonorrhea, but retesting rates have remained stubbornly below 50%. Effective strategies for increasing patient retest return rates have been elusive, she noted.

In the year leading up to the InTOUCH study, only 44% of clinic patients overall were retested, and that was found to be a result both of the low (62%) return rate and low (69%) retesting rate among those who did return, she said.

The overall retesting rate improved to nearly 60% during the course of the study.

"So with a very moderate increase in patient return rates and in clinic retesting rates among returning patients, you can see that we cumulatively increased our overall retesting rates by more than 30%," she said, noting that given the consistently low return rates in prior years, this was "a very exciting result."

The current findings suggest that addressing the factors that contribute to low return rates, including lack of information about the importance of returning, forgetting to return, and difficulties getting to the clinic, can lead to significant improvement in return rates, Ms. Howard said.

"Improving is dependent on addressing both patient and clinic level causes. Through a combination of these very feasible interventions, we were able to increase the overall retesting rates by 32%," she said.

The InTOUCH study was funded by a grant from the Office of Population Affairs as a Title X Service Delivery Improvement Research Project. Ms. Howard reported having no other disclosures.

ATLANTA – Educating patients treated for chlamydia or gonorrhea about reinfection and retesting, and providing customized options for follow-up care, increased patient retest return rates by 15% in a prospective cohort study.

The return rate at 1-6 months after treatment among 1,454 patients who received enhanced educational information about reinfection and the importance of retesting during the first phase of the InTOUCH study was 59%, and the return rate among 575 patients who received that educational information along with customized reminders and/or a mailed-in home testing kit in a second phase was 62%, compared with a return rate of 54% among 2,696 historical controls, Holly Howard reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The increases in return rates were statistically significant, said Ms. Howard of the California Department of Public Health, Richmond.

The initial education phase of the multicenter study occurred in 2010 and 2011 at six geographically diverse California Title X clinics. Participants were clients of the California Family Planning, Access, Care, and Treatment Program, which provides care to more than 2 million low-income women each year.

The patients were counseled about the risks and dangers of re-infection and the importance of retesting, and were given tips for remembering to return for retesting. Additionally, educational materials were updated to improve readability and user friendliness.

During 2011 and 2012, patients from the educational phase who tested positive for chlamydia or gonorrhea, and who were treated for the infections, were officially enrolled in the second phase of the study, during which they were offered the option of receiving retest reminders via postcard, text, and/or e-mail, as well as the option of retesting with a home test sent to their address 3 months after treatment.

Most patients (90%) opted to receive retest reminders, and most of those chose text and e-mail reminders. Only 5% chose to use the home test kit.

The findings have implications for improving the notoriously low return rates among women who test positive for chlamydia and gonorrhea infection. These infections are common and are associated with serious reproductive health sequelae, including an increased risk of pelvic inflammatory disease and ectopic pregnancy, Ms. Howard noted.

Routine retesting within a few months of treatment allows for early identification of reinfection, and for retreatment that can reduce the risk of adverse outcomes.

For more than a decade, national guidelines have recommended retesting of patients with chlamydia or gonorrhea, but retesting rates have remained stubbornly below 50%. Effective strategies for increasing patient retest return rates have been elusive, she noted.

In the year leading up to the InTOUCH study, only 44% of clinic patients overall were retested, and that was found to be a result both of the low (62%) return rate and low (69%) retesting rate among those who did return, she said.

The overall retesting rate improved to nearly 60% during the course of the study.

"So with a very moderate increase in patient return rates and in clinic retesting rates among returning patients, you can see that we cumulatively increased our overall retesting rates by more than 30%," she said, noting that given the consistently low return rates in prior years, this was "a very exciting result."

The current findings suggest that addressing the factors that contribute to low return rates, including lack of information about the importance of returning, forgetting to return, and difficulties getting to the clinic, can lead to significant improvement in return rates, Ms. Howard said.

"Improving is dependent on addressing both patient and clinic level causes. Through a combination of these very feasible interventions, we were able to increase the overall retesting rates by 32%," she said.

The InTOUCH study was funded by a grant from the Office of Population Affairs as a Title X Service Delivery Improvement Research Project. Ms. Howard reported having no other disclosures.

ATLANTA – Educating patients treated for chlamydia or gonorrhea about reinfection and retesting, and providing customized options for follow-up care, increased patient retest return rates by 15% in a prospective cohort study.

The return rate at 1-6 months after treatment among 1,454 patients who received enhanced educational information about reinfection and the importance of retesting during the first phase of the InTOUCH study was 59%, and the return rate among 575 patients who received that educational information along with customized reminders and/or a mailed-in home testing kit in a second phase was 62%, compared with a return rate of 54% among 2,696 historical controls, Holly Howard reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The increases in return rates were statistically significant, said Ms. Howard of the California Department of Public Health, Richmond.

The initial education phase of the multicenter study occurred in 2010 and 2011 at six geographically diverse California Title X clinics. Participants were clients of the California Family Planning, Access, Care, and Treatment Program, which provides care to more than 2 million low-income women each year.

The patients were counseled about the risks and dangers of re-infection and the importance of retesting, and were given tips for remembering to return for retesting. Additionally, educational materials were updated to improve readability and user friendliness.

During 2011 and 2012, patients from the educational phase who tested positive for chlamydia or gonorrhea, and who were treated for the infections, were officially enrolled in the second phase of the study, during which they were offered the option of receiving retest reminders via postcard, text, and/or e-mail, as well as the option of retesting with a home test sent to their address 3 months after treatment.

Most patients (90%) opted to receive retest reminders, and most of those chose text and e-mail reminders. Only 5% chose to use the home test kit.

The findings have implications for improving the notoriously low return rates among women who test positive for chlamydia and gonorrhea infection. These infections are common and are associated with serious reproductive health sequelae, including an increased risk of pelvic inflammatory disease and ectopic pregnancy, Ms. Howard noted.

Routine retesting within a few months of treatment allows for early identification of reinfection, and for retreatment that can reduce the risk of adverse outcomes.

For more than a decade, national guidelines have recommended retesting of patients with chlamydia or gonorrhea, but retesting rates have remained stubbornly below 50%. Effective strategies for increasing patient retest return rates have been elusive, she noted.

In the year leading up to the InTOUCH study, only 44% of clinic patients overall were retested, and that was found to be a result both of the low (62%) return rate and low (69%) retesting rate among those who did return, she said.

The overall retesting rate improved to nearly 60% during the course of the study.

"So with a very moderate increase in patient return rates and in clinic retesting rates among returning patients, you can see that we cumulatively increased our overall retesting rates by more than 30%," she said, noting that given the consistently low return rates in prior years, this was "a very exciting result."

The current findings suggest that addressing the factors that contribute to low return rates, including lack of information about the importance of returning, forgetting to return, and difficulties getting to the clinic, can lead to significant improvement in return rates, Ms. Howard said.

"Improving is dependent on addressing both patient and clinic level causes. Through a combination of these very feasible interventions, we were able to increase the overall retesting rates by 32%," she said.

The InTOUCH study was funded by a grant from the Office of Population Affairs as a Title X Service Delivery Improvement Research Project. Ms. Howard reported having no other disclosures.

ATLANTA – Educating patients treated for chlamydia or gonorrhea about reinfection and retesting, and providing customized options for follow-up care, increased patient retest return rates by 15% in a prospective cohort study.

The return rate at 1-6 months after treatment among 1,454 patients who received enhanced educational information about reinfection and the importance of retesting during the first phase of the InTOUCH study was 59%, and the return rate among 575 patients who received that educational information along with customized reminders and/or a mailed-in home testing kit in a second phase was 62%, compared with a return rate of 54% among 2,696 historical controls, Holly Howard reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The increases in return rates were statistically significant, said Ms. Howard of the California Department of Public Health, Richmond.

The initial education phase of the multicenter study occurred in 2010 and 2011 at six geographically diverse California Title X clinics. Participants were clients of the California Family Planning, Access, Care, and Treatment Program, which provides care to more than 2 million low-income women each year.

The patients were counseled about the risks and dangers of re-infection and the importance of retesting, and were given tips for remembering to return for retesting. Additionally, educational materials were updated to improve readability and user friendliness.

During 2011 and 2012, patients from the educational phase who tested positive for chlamydia or gonorrhea, and who were treated for the infections, were officially enrolled in the second phase of the study, during which they were offered the option of receiving retest reminders via postcard, text, and/or e-mail, as well as the option of retesting with a home test sent to their address 3 months after treatment.

Most patients (90%) opted to receive retest reminders, and most of those chose text and e-mail reminders. Only 5% chose to use the home test kit.

The findings have implications for improving the notoriously low return rates among women who test positive for chlamydia and gonorrhea infection. These infections are common and are associated with serious reproductive health sequelae, including an increased risk of pelvic inflammatory disease and ectopic pregnancy, Ms. Howard noted.

Routine retesting within a few months of treatment allows for early identification of reinfection, and for retreatment that can reduce the risk of adverse outcomes.

For more than a decade, national guidelines have recommended retesting of patients with chlamydia or gonorrhea, but retesting rates have remained stubbornly below 50%. Effective strategies for increasing patient retest return rates have been elusive, she noted.

In the year leading up to the InTOUCH study, only 44% of clinic patients overall were retested, and that was found to be a result both of the low (62%) return rate and low (69%) retesting rate among those who did return, she said.

The overall retesting rate improved to nearly 60% during the course of the study.

"So with a very moderate increase in patient return rates and in clinic retesting rates among returning patients, you can see that we cumulatively increased our overall retesting rates by more than 30%," she said, noting that given the consistently low return rates in prior years, this was "a very exciting result."

The current findings suggest that addressing the factors that contribute to low return rates, including lack of information about the importance of returning, forgetting to return, and difficulties getting to the clinic, can lead to significant improvement in return rates, Ms. Howard said.

"Improving is dependent on addressing both patient and clinic level causes. Through a combination of these very feasible interventions, we were able to increase the overall retesting rates by 32%," she said.

The InTOUCH study was funded by a grant from the Office of Population Affairs as a Title X Service Delivery Improvement Research Project. Ms. Howard reported having no other disclosures.

ATLANTA – Educating patients treated for chlamydia or gonorrhea about reinfection and retesting, and providing customized options for follow-up care, increased patient retest return rates by 15% in a prospective cohort study.

The return rate at 1-6 months after treatment among 1,454 patients who received enhanced educational information about reinfection and the importance of retesting during the first phase of the InTOUCH study was 59%, and the return rate among 575 patients who received that educational information along with customized reminders and/or a mailed-in home testing kit in a second phase was 62%, compared with a return rate of 54% among 2,696 historical controls, Holly Howard reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The increases in return rates were statistically significant, said Ms. Howard of the California Department of Public Health, Richmond.

The initial education phase of the multicenter study occurred in 2010 and 2011 at six geographically diverse California Title X clinics. Participants were clients of the California Family Planning, Access, Care, and Treatment Program, which provides care to more than 2 million low-income women each year.

The patients were counseled about the risks and dangers of re-infection and the importance of retesting, and were given tips for remembering to return for retesting. Additionally, educational materials were updated to improve readability and user friendliness.

During 2011 and 2012, patients from the educational phase who tested positive for chlamydia or gonorrhea, and who were treated for the infections, were officially enrolled in the second phase of the study, during which they were offered the option of receiving retest reminders via postcard, text, and/or e-mail, as well as the option of retesting with a home test sent to their address 3 months after treatment.

Most patients (90%) opted to receive retest reminders, and most of those chose text and e-mail reminders. Only 5% chose to use the home test kit.

The findings have implications for improving the notoriously low return rates among women who test positive for chlamydia and gonorrhea infection. These infections are common and are associated with serious reproductive health sequelae, including an increased risk of pelvic inflammatory disease and ectopic pregnancy, Ms. Howard noted.

Routine retesting within a few months of treatment allows for early identification of reinfection, and for retreatment that can reduce the risk of adverse outcomes.

For more than a decade, national guidelines have recommended retesting of patients with chlamydia or gonorrhea, but retesting rates have remained stubbornly below 50%. Effective strategies for increasing patient retest return rates have been elusive, she noted.

In the year leading up to the InTOUCH study, only 44% of clinic patients overall were retested, and that was found to be a result both of the low (62%) return rate and low (69%) retesting rate among those who did return, she said.

The overall retesting rate improved to nearly 60% during the course of the study.

"So with a very moderate increase in patient return rates and in clinic retesting rates among returning patients, you can see that we cumulatively increased our overall retesting rates by more than 30%," she said, noting that given the consistently low return rates in prior years, this was "a very exciting result."

The current findings suggest that addressing the factors that contribute to low return rates, including lack of information about the importance of returning, forgetting to return, and difficulties getting to the clinic, can lead to significant improvement in return rates, Ms. Howard said.

"Improving is dependent on addressing both patient and clinic level causes. Through a combination of these very feasible interventions, we were able to increase the overall retesting rates by 32%," she said.

The InTOUCH study was funded by a grant from the Office of Population Affairs as a Title X Service Delivery Improvement Research Project. Ms. Howard reported having no other disclosures.

ATLANTA – Prenatal screening for chlamydia and gonorrhea is commonly performed in conjunction with Pap testing, which results in low screening rates among those who don’t undergo Pap testing, a retrospective cohort study showed.

These findings are concerning because recent changes in cervical cancer screening recommendations that increase the screening interval for many women could further reduce the rates of screening for chlamydia and gonorrhea if clinicians don’t "untie" Pap testing and STD screening, Dr. Christine Ross said at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

Courtesy CDC

Among 63,332 pregnant women with a live birth who were included in a 12-state Medicaid claims database in 2009-2010, 79% were tested for chlamydia, 72% were tested for gonorrhea, and 74% underwent cervical cancer screening by Pap test. Of the 46,966 who underwent Pap testing, 89% and 80% were tested for chlamydia and gonorrhea, respectively, and of those who did not undergo Pap testing, only 51% and 48% were tested for chlamydia and gonorrhea, said Dr. Ross of the division of STD prevention at the CDC.

"We found that 13% of women in our study population had neither a Pap test nor a chlamydia or gonorrhea screening test," she said.

Women included in the current analysis were aged 15-24 years, and were enrolled in Medicaid continuously for at least 210 days at the time of delivery. The women had numerous prenatal visits, and thus had ample opportunity for screening.

The CDC recommends universal chlamydia screening in pregnant women, with screening at the first prenatal visit, and recommends gonorrhea screening of pregnant women at risk, which includes those under age 25 years and those with a prior infection. Repeat screening in the third trimester is recommended for certain high-risk patients.

In 2012 the U.S. Preventive Services Task Force revised its cervical cancer screening guidelines, and screening is no longer recommended in women younger than 21 years. Also, the interval for screening was extended to 3 years for those over age 21 years, Dr. Ross noted.

The findings are concerning for several reasons, she said.

The vast majority of chlamydia and gonorrhea infections are asymptomatic, including those occurring during pregnancy. Studies show that only 5%-35% of patients with laboratory-confirmed infections develop symptoms. Furthermore, both chlamydia and gonorrhea can affect neonates and can lead to adverse outcomes in pregnant women, she explained.

Furthermore, in one large study involving laboratory data for 1.3 million pregnant women, nearly 16% of 16-year-olds tested positive for chlamydia, and 3% tested positive for gonorrhea. The rate of positive tests declined with advancing maternal age – a finding that is consistent with CDC data, Dr. Ross noted.

Yet, under the revised guidelines, the younger women – who are at the highest risk of infection – would be less likely to be tested.

For many years, screening for chlamydia and gonorrhea was performed at the time of Pap testing, using the endocervical sample, but improved understanding of human papillomavirus infection in young women led to the revision of the guidelines.

Although limited by factors inherent in using administrative data, and by the underrepresentation of Hispanics, who comprised only 3.6% of the sample, the current findings suggest that a reduction in chlamydia and gonorrhea screening may be an inadvertent consequence of the changes.

Future studies are warranted to evaluate this potential consequence as more providers implement the new cervical cancer screening recommendations, Dr. Ross said.

"In the meantime, we recommended informing prenatal providers about the importance of screening all pregnant women for chlamydia and those at risk for gonorrhea, and that alternative specimen collection methods that do not require a pelvic examination that is done during a Pap test are available – and in fact are preferred," she said, noting that patient- or provider-collected vaginal swabs are the preferred specimen, and that urine also can be used.

Dr. Ross reported having no disclosures.

ATLANTA – Prenatal screening for chlamydia and gonorrhea is commonly performed in conjunction with Pap testing, which results in low screening rates among those who don’t undergo Pap testing, a retrospective cohort study showed.

These findings are concerning because recent changes in cervical cancer screening recommendations that increase the screening interval for many women could further reduce the rates of screening for chlamydia and gonorrhea if clinicians don’t "untie" Pap testing and STD screening, Dr. Christine Ross said at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

Courtesy CDC

Among 63,332 pregnant women with a live birth who were included in a 12-state Medicaid claims database in 2009-2010, 79% were tested for chlamydia, 72% were tested for gonorrhea, and 74% underwent cervical cancer screening by Pap test. Of the 46,966 who underwent Pap testing, 89% and 80% were tested for chlamydia and gonorrhea, respectively, and of those who did not undergo Pap testing, only 51% and 48% were tested for chlamydia and gonorrhea, said Dr. Ross of the division of STD prevention at the CDC.

"We found that 13% of women in our study population had neither a Pap test nor a chlamydia or gonorrhea screening test," she said.

Women included in the current analysis were aged 15-24 years, and were enrolled in Medicaid continuously for at least 210 days at the time of delivery. The women had numerous prenatal visits, and thus had ample opportunity for screening.

The CDC recommends universal chlamydia screening in pregnant women, with screening at the first prenatal visit, and recommends gonorrhea screening of pregnant women at risk, which includes those under age 25 years and those with a prior infection. Repeat screening in the third trimester is recommended for certain high-risk patients.

In 2012 the U.S. Preventive Services Task Force revised its cervical cancer screening guidelines, and screening is no longer recommended in women younger than 21 years. Also, the interval for screening was extended to 3 years for those over age 21 years, Dr. Ross noted.

The findings are concerning for several reasons, she said.

The vast majority of chlamydia and gonorrhea infections are asymptomatic, including those occurring during pregnancy. Studies show that only 5%-35% of patients with laboratory-confirmed infections develop symptoms. Furthermore, both chlamydia and gonorrhea can affect neonates and can lead to adverse outcomes in pregnant women, she explained.

Furthermore, in one large study involving laboratory data for 1.3 million pregnant women, nearly 16% of 16-year-olds tested positive for chlamydia, and 3% tested positive for gonorrhea. The rate of positive tests declined with advancing maternal age – a finding that is consistent with CDC data, Dr. Ross noted.

Yet, under the revised guidelines, the younger women – who are at the highest risk of infection – would be less likely to be tested.

For many years, screening for chlamydia and gonorrhea was performed at the time of Pap testing, using the endocervical sample, but improved understanding of human papillomavirus infection in young women led to the revision of the guidelines.

Although limited by factors inherent in using administrative data, and by the underrepresentation of Hispanics, who comprised only 3.6% of the sample, the current findings suggest that a reduction in chlamydia and gonorrhea screening may be an inadvertent consequence of the changes.

Future studies are warranted to evaluate this potential consequence as more providers implement the new cervical cancer screening recommendations, Dr. Ross said.

"In the meantime, we recommended informing prenatal providers about the importance of screening all pregnant women for chlamydia and those at risk for gonorrhea, and that alternative specimen collection methods that do not require a pelvic examination that is done during a Pap test are available – and in fact are preferred," she said, noting that patient- or provider-collected vaginal swabs are the preferred specimen, and that urine also can be used.

Dr. Ross reported having no disclosures.

ATLANTA – Prenatal screening for chlamydia and gonorrhea is commonly performed in conjunction with Pap testing, which results in low screening rates among those who don’t undergo Pap testing, a retrospective cohort study showed.

These findings are concerning because recent changes in cervical cancer screening recommendations that increase the screening interval for many women could further reduce the rates of screening for chlamydia and gonorrhea if clinicians don’t "untie" Pap testing and STD screening, Dr. Christine Ross said at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

Courtesy CDC

Among 63,332 pregnant women with a live birth who were included in a 12-state Medicaid claims database in 2009-2010, 79% were tested for chlamydia, 72% were tested for gonorrhea, and 74% underwent cervical cancer screening by Pap test. Of the 46,966 who underwent Pap testing, 89% and 80% were tested for chlamydia and gonorrhea, respectively, and of those who did not undergo Pap testing, only 51% and 48% were tested for chlamydia and gonorrhea, said Dr. Ross of the division of STD prevention at the CDC.

"We found that 13% of women in our study population had neither a Pap test nor a chlamydia or gonorrhea screening test," she said.

Women included in the current analysis were aged 15-24 years, and were enrolled in Medicaid continuously for at least 210 days at the time of delivery. The women had numerous prenatal visits, and thus had ample opportunity for screening.

The CDC recommends universal chlamydia screening in pregnant women, with screening at the first prenatal visit, and recommends gonorrhea screening of pregnant women at risk, which includes those under age 25 years and those with a prior infection. Repeat screening in the third trimester is recommended for certain high-risk patients.

In 2012 the U.S. Preventive Services Task Force revised its cervical cancer screening guidelines, and screening is no longer recommended in women younger than 21 years. Also, the interval for screening was extended to 3 years for those over age 21 years, Dr. Ross noted.

The findings are concerning for several reasons, she said.

The vast majority of chlamydia and gonorrhea infections are asymptomatic, including those occurring during pregnancy. Studies show that only 5%-35% of patients with laboratory-confirmed infections develop symptoms. Furthermore, both chlamydia and gonorrhea can affect neonates and can lead to adverse outcomes in pregnant women, she explained.

Furthermore, in one large study involving laboratory data for 1.3 million pregnant women, nearly 16% of 16-year-olds tested positive for chlamydia, and 3% tested positive for gonorrhea. The rate of positive tests declined with advancing maternal age – a finding that is consistent with CDC data, Dr. Ross noted.

Yet, under the revised guidelines, the younger women – who are at the highest risk of infection – would be less likely to be tested.

For many years, screening for chlamydia and gonorrhea was performed at the time of Pap testing, using the endocervical sample, but improved understanding of human papillomavirus infection in young women led to the revision of the guidelines.

Although limited by factors inherent in using administrative data, and by the underrepresentation of Hispanics, who comprised only 3.6% of the sample, the current findings suggest that a reduction in chlamydia and gonorrhea screening may be an inadvertent consequence of the changes.

Future studies are warranted to evaluate this potential consequence as more providers implement the new cervical cancer screening recommendations, Dr. Ross said.

"In the meantime, we recommended informing prenatal providers about the importance of screening all pregnant women for chlamydia and those at risk for gonorrhea, and that alternative specimen collection methods that do not require a pelvic examination that is done during a Pap test are available – and in fact are preferred," she said, noting that patient- or provider-collected vaginal swabs are the preferred specimen, and that urine also can be used.

Dr. Ross reported having no disclosures.

ATLANTA – Gonorrhea reinfection rates are high among women in Florida, with more than 1 in 4 becoming reinfected after treatment, according to a review of surveillance data.

Of 9,923 female Florida residents with a reported gonorrhea infection in 2000, 27% had an additional infection reported within 10 years, and of 9,617 women with a gonorrhea infection reported in 2011, 23% had an earlier infection reported in the previous 10 years, Daniel R. Newman of the Centers for Disease Control and Prevention, Atlanta, reported in a poster at a conference on STD prevention sponsored by the CDC.

Centers for Disease Control and Prevention

During 2000-2011, there were 127,081 gonorrhea infections reported among 103,156 women and girls aged 13 years and older, and the number of infections per year ranged from 9,345 to 11,970. Repeat infections occurred in 17,500 individuals.

The mean time to reported reinfection was 2.1 years; the median time was 1.28 years, Mr. Newman noted.

Most reinfections (74%) occurred in African Americans at a median age of 19 years at first diagnosis; 22% of African American women and girls and 14% of white women and girls with an infection in 2000 were reinfected at least once over the next decade, highlighting a 57% racial disparity in reinfection rates.

Additionally, 16% of 1,059 women who were HIV positive at the time of their first reported gonococcal infection were reinfected, indicating possible risk of HIV transmission to partners.

Since gonorrhea is often asymptomatic, and since a history of infections prior to 2000 was unavailable, it is likely that these findings underestimate the incidence of gonorrhea infection and reinfection, Mr. Newman reported.

Also, some women with an initial gonorrhea infection may have left the state after their initial infection; thus reinfection in those women would not have been captured, and some women may have moved to the state after an initial infection and thus would not be listed as a repeater.

The findings underscore the need to follow recommendations regarding rescreening of patients with gonorrhea after their initial diagnosis, Mr. Newman concluded, noting that partner services, including expedited partner therapy, and high-intensity behavioral counseling have been shown to reduce reinfection rates.

Mr. Newman reported having no disclosures.

ATLANTA – Gonorrhea reinfection rates are high among women in Florida, with more than 1 in 4 becoming reinfected after treatment, according to a review of surveillance data.

Of 9,923 female Florida residents with a reported gonorrhea infection in 2000, 27% had an additional infection reported within 10 years, and of 9,617 women with a gonorrhea infection reported in 2011, 23% had an earlier infection reported in the previous 10 years, Daniel R. Newman of the Centers for Disease Control and Prevention, Atlanta, reported in a poster at a conference on STD prevention sponsored by the CDC.

Centers for Disease Control and Prevention

During 2000-2011, there were 127,081 gonorrhea infections reported among 103,156 women and girls aged 13 years and older, and the number of infections per year ranged from 9,345 to 11,970. Repeat infections occurred in 17,500 individuals.

The mean time to reported reinfection was 2.1 years; the median time was 1.28 years, Mr. Newman noted.

Most reinfections (74%) occurred in African Americans at a median age of 19 years at first diagnosis; 22% of African American women and girls and 14% of white women and girls with an infection in 2000 were reinfected at least once over the next decade, highlighting a 57% racial disparity in reinfection rates.

Additionally, 16% of 1,059 women who were HIV positive at the time of their first reported gonococcal infection were reinfected, indicating possible risk of HIV transmission to partners.

Since gonorrhea is often asymptomatic, and since a history of infections prior to 2000 was unavailable, it is likely that these findings underestimate the incidence of gonorrhea infection and reinfection, Mr. Newman reported.

Also, some women with an initial gonorrhea infection may have left the state after their initial infection; thus reinfection in those women would not have been captured, and some women may have moved to the state after an initial infection and thus would not be listed as a repeater.

The findings underscore the need to follow recommendations regarding rescreening of patients with gonorrhea after their initial diagnosis, Mr. Newman concluded, noting that partner services, including expedited partner therapy, and high-intensity behavioral counseling have been shown to reduce reinfection rates.

Mr. Newman reported having no disclosures.

ATLANTA – Gonorrhea reinfection rates are high among women in Florida, with more than 1 in 4 becoming reinfected after treatment, according to a review of surveillance data.

Of 9,923 female Florida residents with a reported gonorrhea infection in 2000, 27% had an additional infection reported within 10 years, and of 9,617 women with a gonorrhea infection reported in 2011, 23% had an earlier infection reported in the previous 10 years, Daniel R. Newman of the Centers for Disease Control and Prevention, Atlanta, reported in a poster at a conference on STD prevention sponsored by the CDC.

Centers for Disease Control and Prevention

During 2000-2011, there were 127,081 gonorrhea infections reported among 103,156 women and girls aged 13 years and older, and the number of infections per year ranged from 9,345 to 11,970. Repeat infections occurred in 17,500 individuals.

The mean time to reported reinfection was 2.1 years; the median time was 1.28 years, Mr. Newman noted.

Most reinfections (74%) occurred in African Americans at a median age of 19 years at first diagnosis; 22% of African American women and girls and 14% of white women and girls with an infection in 2000 were reinfected at least once over the next decade, highlighting a 57% racial disparity in reinfection rates.

Additionally, 16% of 1,059 women who were HIV positive at the time of their first reported gonococcal infection were reinfected, indicating possible risk of HIV transmission to partners.

Since gonorrhea is often asymptomatic, and since a history of infections prior to 2000 was unavailable, it is likely that these findings underestimate the incidence of gonorrhea infection and reinfection, Mr. Newman reported.

Also, some women with an initial gonorrhea infection may have left the state after their initial infection; thus reinfection in those women would not have been captured, and some women may have moved to the state after an initial infection and thus would not be listed as a repeater.

The findings underscore the need to follow recommendations regarding rescreening of patients with gonorrhea after their initial diagnosis, Mr. Newman concluded, noting that partner services, including expedited partner therapy, and high-intensity behavioral counseling have been shown to reduce reinfection rates.

Mr. Newman reported having no disclosures.

ATLANTA – Gonorrhea reinfection rates are high among women in Florida, with more than 1 in 4 becoming reinfected after treatment, according to a review of surveillance data.

Of 9,923 female Florida residents with a reported gonorrhea infection in 2000, 27% had an additional infection reported within 10 years, and of 9,617 women with a gonorrhea infection reported in 2011, 23% had an earlier infection reported in the previous 10 years, Daniel R. Newman of the Centers for Disease Control and Prevention, Atlanta, reported in a poster at a conference on STD prevention sponsored by the CDC.

Centers for Disease Control and Prevention

During 2000-2011, there were 127,081 gonorrhea infections reported among 103,156 women and girls aged 13 years and older, and the number of infections per year ranged from 9,345 to 11,970. Repeat infections occurred in 17,500 individuals.

The mean time to reported reinfection was 2.1 years; the median time was 1.28 years, Mr. Newman noted.

Most reinfections (74%) occurred in African Americans at a median age of 19 years at first diagnosis; 22% of African American women and girls and 14% of white women and girls with an infection in 2000 were reinfected at least once over the next decade, highlighting a 57% racial disparity in reinfection rates.

Additionally, 16% of 1,059 women who were HIV positive at the time of their first reported gonococcal infection were reinfected, indicating possible risk of HIV transmission to partners.

Since gonorrhea is often asymptomatic, and since a history of infections prior to 2000 was unavailable, it is likely that these findings underestimate the incidence of gonorrhea infection and reinfection, Mr. Newman reported.

Also, some women with an initial gonorrhea infection may have left the state after their initial infection; thus reinfection in those women would not have been captured, and some women may have moved to the state after an initial infection and thus would not be listed as a repeater.

The findings underscore the need to follow recommendations regarding rescreening of patients with gonorrhea after their initial diagnosis, Mr. Newman concluded, noting that partner services, including expedited partner therapy, and high-intensity behavioral counseling have been shown to reduce reinfection rates.

Mr. Newman reported having no disclosures.

ATLANTA – Gonorrhea reinfection rates are high among women in Florida, with more than 1 in 4 becoming reinfected after treatment, according to a review of surveillance data.

Of 9,923 female Florida residents with a reported gonorrhea infection in 2000, 27% had an additional infection reported within 10 years, and of 9,617 women with a gonorrhea infection reported in 2011, 23% had an earlier infection reported in the previous 10 years, Daniel R. Newman of the Centers for Disease Control and Prevention, Atlanta, reported in a poster at a conference on STD prevention sponsored by the CDC.

Centers for Disease Control and Prevention

During 2000-2011, there were 127,081 gonorrhea infections reported among 103,156 women and girls aged 13 years and older, and the number of infections per year ranged from 9,345 to 11,970. Repeat infections occurred in 17,500 individuals.

The mean time to reported reinfection was 2.1 years; the median time was 1.28 years, Mr. Newman noted.

Most reinfections (74%) occurred in African Americans at a median age of 19 years at first diagnosis; 22% of African American women and girls and 14% of white women and girls with an infection in 2000 were reinfected at least once over the next decade, highlighting a 57% racial disparity in reinfection rates.

Additionally, 16% of 1,059 women who were HIV positive at the time of their first reported gonococcal infection were reinfected, indicating possible risk of HIV transmission to partners.

Since gonorrhea is often asymptomatic, and since a history of infections prior to 2000 was unavailable, it is likely that these findings underestimate the incidence of gonorrhea infection and reinfection, Mr. Newman reported.

Also, some women with an initial gonorrhea infection may have left the state after their initial infection; thus reinfection in those women would not have been captured, and some women may have moved to the state after an initial infection and thus would not be listed as a repeater.

The findings underscore the need to follow recommendations regarding rescreening of patients with gonorrhea after their initial diagnosis, Mr. Newman concluded, noting that partner services, including expedited partner therapy, and high-intensity behavioral counseling have been shown to reduce reinfection rates.

Mr. Newman reported having no disclosures.

ATLANTA – Gonorrhea reinfection rates are high among women in Florida, with more than 1 in 4 becoming reinfected after treatment, according to a review of surveillance data.

Of 9,923 female Florida residents with a reported gonorrhea infection in 2000, 27% had an additional infection reported within 10 years, and of 9,617 women with a gonorrhea infection reported in 2011, 23% had an earlier infection reported in the previous 10 years, Daniel R. Newman of the Centers for Disease Control and Prevention, Atlanta, reported in a poster at a conference on STD prevention sponsored by the CDC.

Centers for Disease Control and Prevention

During 2000-2011, there were 127,081 gonorrhea infections reported among 103,156 women and girls aged 13 years and older, and the number of infections per year ranged from 9,345 to 11,970. Repeat infections occurred in 17,500 individuals.

The mean time to reported reinfection was 2.1 years; the median time was 1.28 years, Mr. Newman noted.

Most reinfections (74%) occurred in African Americans at a median age of 19 years at first diagnosis; 22% of African American women and girls and 14% of white women and girls with an infection in 2000 were reinfected at least once over the next decade, highlighting a 57% racial disparity in reinfection rates.

Additionally, 16% of 1,059 women who were HIV positive at the time of their first reported gonococcal infection were reinfected, indicating possible risk of HIV transmission to partners.

Since gonorrhea is often asymptomatic, and since a history of infections prior to 2000 was unavailable, it is likely that these findings underestimate the incidence of gonorrhea infection and reinfection, Mr. Newman reported.

Also, some women with an initial gonorrhea infection may have left the state after their initial infection; thus reinfection in those women would not have been captured, and some women may have moved to the state after an initial infection and thus would not be listed as a repeater.

The findings underscore the need to follow recommendations regarding rescreening of patients with gonorrhea after their initial diagnosis, Mr. Newman concluded, noting that partner services, including expedited partner therapy, and high-intensity behavioral counseling have been shown to reduce reinfection rates.

Mr. Newman reported having no disclosures.